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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601193
Report Date: 02/10/2025
Date Signed: 02/10/2025 12:35:49 PM

Document Has Been Signed on 02/10/2025 12:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:DUCRE'S RESIDENTIAL CAREFACILITY NUMBER:
075601193
ADMINISTRATOR/
DIRECTOR:
DUCRE, DORIS RUTHFACILITY TYPE:
740
ADDRESS:4400 BELL AVENUETELEPHONE:
(510) 236-8776
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY: 6CENSUS: 5DATE:
02/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Doris Ducre, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 02/09/23 at 08:50 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection. LPA was greeted by the Administrator (ADM), Doris Ducre at the entry and explained the purpose of the visit.

Facility has a COVID-19 mitigation plan and EDP plan on file. LPA reviewed a staff and resident roster. LPA observed a visitor sign-in log at the entry. There is a surplus of PPE stored inside the facility that is accessible to all care staff that includes hand sanitizer, masks, face shields, gowns, shoe covers, goggles, and gloves. LPA observed masks, cough etiquette, social distancing hand washing, and COVID-19 signs posted throughout. LPA toured the facility including, but not limited to common areas, bathrooms, bedrooms, kitchen, storage, garage and backyard. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap, paper towels and covered garbage cans. The hot water temperature was measured at 117.9 degrees Fahrenheit (F) and the facility's temperature was a comfortable degrees while cleaning & disinfecting during the visit. Fire extinguisher was observed full and exp. 02/19/24. Smoke/Carbon Monoxide detectors were observed operational and first aid flipper card and supplies for kit were available.

The following forms are to be updated and submitted to CCLD:
-LIC500 Personnel Report (Reviewed)
-LIC308 Designation of Administrative Responsibility (Reviewed)
-LIC610 Emergency Disaster Plan (Reviewed)
-An updated copy of Administrator Certificate(s) (Reviewed)

Exit interview conducted and a copy of this report provided Doris Ducre.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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